The statistics have been around for quite some time and keep getting worse. Based on the latest data from the World Health Organization (WHO), non-communicable diseases (NCDs) are the leading cause of death globally, with three out of four (approximately 74%–75%) deaths being attributed to them. They kill approximately 43 million people each year, which accounts for 71% to 75% of all global deaths. In India, that number is above 60%.
“More than half of the world’s population lives in cities now and that will go up to 70 per cent by 2050. Cities are more agile and we need to look at activating mayoral systems. Mayors are more connected to their communities and divestment of monitoring public health is more cost-effective,” says Dr Krug.
How is the burden of diseases shifting according to you?
The burden of disease was dominated by infectious diseases. We are now seeing a rapid shift towards NCDs. Tobacco consumption, alcohol consumption and physical inactivity are among the biggest killers. While tobacco awareness campaigns are ongoing for some time, tobacco still kills seven million people. That’s why an aggressive preventive campaign is needed for NCDs, led by cities. Urban residents are often more exposed to risk factors such as polluted air, an unhealthy food environment and unsafe streets than their rural counterparts. Besides, cities have the local knowledge to drive targeted solutions.
The WHO first included obesity in the International Classification of Diseases (ICD) in 1948 and classified it as a chronic disease in 1997. Do you think it should have been classified as a disease earlier?
Frankly, the past is the past. What matters now is that we really tackle this rapidly growing public health problem. So, we at WHO are really putting a lot of energy on how to measure obesity, on prevention efforts and limiting the consequences on chronic disease. That’s what matters right now.
Since South Asians develop chronic illnesses 10 years earlier than other population groups, how can governments make people aware of the need to focus on preventive health? How do you see the risks in India?
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Common people have a baseline awareness of the rise in NCDs. They may not always be aware of the risk factors and the need for prevention, which involves increased physical activity, decreased smoking, alcohol consumption and lowering consumption of unhealthy foods. They’re also not always aware of the commercial practices that drive some of these risk factors and may be victims of strategies of the private sector in marketing, be it campaigns that silently push tobacco products, unhealthy foods and alcohol to young people.
These practices may be new to some of these markets which are opening up. And the middle class, which is rapidly growing, has more access to some of these products now. That’s why we need to make sure that food legislation is updated and enforced on limiting some of these risk factors.
India is a rapidly changing society and it could avoid some of the pitfalls that other societies have gone through. And that’s why we want to facilitate exchange of good practices between cities. For example, in India, there is now an intervention to display sugar boards in schools. School nutrition policies are having an impact. In London, where rising NCD rates among children were disproportionately impacting lower-income areas, the city’s 2019 junk food advertising restrictions in public transportation are estimated to have prevented obesity. From Rio in Brazil to Córdoba in Argentina, removing junk food and sugary drinks from schools have improved health indices of children. The changes gained local support because policymakers could show evidence that such early interventions positively shape children’s health by influencing consumption patterns and decision-making throughout life.
As India is now putting in place measures to avoid consumption of unhealthy products, facilitating physical activity, too, is extremely important. For example, road traffic crashes continue to be a very big issue in India. This is a problem in itself because it kills people, particularly young people. But it also limits physical activity because of the lack of walkable spaces. As Indian cities develop, they must make sure that there are sidewalks, opportunities for cycling and there is good public transportation. It is much easier to do these when a city grows and develops rather than retrofitting afterwards when we realise that people are dying.
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Have you had any conversations about such policy changes with Indian leaders?
Yes, there is an ongoing dialogue with health ministry officials on tobacco issues and physical activity. I’ve personally met with the Union Minister of Transport several times on safe pedestrian corridors. This is a big challenge that the whole world is facing, not just India. So, let’s make the infrastructure safe. Let’s increase the price on tobacco, alcohol, sugary drinks by raising taxes. Let’s put a system in place to make prevention almost obligatory.
Unfortunately, communication is very stratified, so only a certain class of people understands it. But we really need to make awareness comprehensible to the lowest primary level in underprivileged areas.
